Health plan enrollment and mortality in the medicare program

Bryan E Dowd, Matthew L. Maciejewski, Heidi L O'Connor, Gerald Riley, Yisong Geng

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Prior studies have found thatMedicare health maintenance organization (HMO) enrollees have lower mortality (over a fixed observation period) than beneficiaries in traditional fee-for-service (FFS) Medicare. We use Medicare Current Beneficiary Survey (MCBS) data to compare 2-year predicted mortality for Medicare enrollees in the HMO and FFS sectors using a sample selection model to control for observed beneficiaries characteristics and unobserved confounders. The difference in raw, unadjusted mortality probabilities was 0.5% (HMO lower). Correcting for numerous observed confounders resulted in a difference of -0.6%(HMO higher). Further adjustment for unobserved confounders resulted in an estimated difference of 3.7 and 4.2% (HMO lower), depending on the specification of geographic-fixed effects. The latter result (4.2%) was statistically significant and consistent with prior studies that did not adjust for unobserved confounding. Our findings suggest there may be unobserved confounders associated with adverse selection in the HMO sector, which had a large effect on our mortality estimates among HMO enrollees. An important topic for further research is to identify such confounders and explore their relationship to mortality. The methods presented in this paper represent a promising approach to comparing outcomes between the HMO and FFS sectors, but further research is warranted.

Original languageEnglish (US)
Pages (from-to)645-659
Number of pages15
JournalHealth Economics
Volume20
Issue number6
DOIs
StatePublished - Jun 1 2011

Fingerprint

Health Maintenance Organizations
Medicare
Mortality
Health
Fee-for-Service Plans
Research
Observation

Keywords

  • HMOs
  • Medicare
  • Mortality

Cite this

Dowd, B. E., Maciejewski, M. L., O'Connor, H. L., Riley, G., & Geng, Y. (2011). Health plan enrollment and mortality in the medicare program. Health Economics, 20(6), 645-659. https://doi.org/10.1002/hec.1623

Health plan enrollment and mortality in the medicare program. / Dowd, Bryan E; Maciejewski, Matthew L.; O'Connor, Heidi L; Riley, Gerald; Geng, Yisong.

In: Health Economics, Vol. 20, No. 6, 01.06.2011, p. 645-659.

Research output: Contribution to journalArticle

Dowd, BE, Maciejewski, ML, O'Connor, HL, Riley, G & Geng, Y 2011, 'Health plan enrollment and mortality in the medicare program', Health Economics, vol. 20, no. 6, pp. 645-659. https://doi.org/10.1002/hec.1623
Dowd BE, Maciejewski ML, O'Connor HL, Riley G, Geng Y. Health plan enrollment and mortality in the medicare program. Health Economics. 2011 Jun 1;20(6):645-659. https://doi.org/10.1002/hec.1623
Dowd, Bryan E ; Maciejewski, Matthew L. ; O'Connor, Heidi L ; Riley, Gerald ; Geng, Yisong. / Health plan enrollment and mortality in the medicare program. In: Health Economics. 2011 ; Vol. 20, No. 6. pp. 645-659.
@article{98ecebe2914247798201b1b82db7b38f,
title = "Health plan enrollment and mortality in the medicare program",
abstract = "Prior studies have found thatMedicare health maintenance organization (HMO) enrollees have lower mortality (over a fixed observation period) than beneficiaries in traditional fee-for-service (FFS) Medicare. We use Medicare Current Beneficiary Survey (MCBS) data to compare 2-year predicted mortality for Medicare enrollees in the HMO and FFS sectors using a sample selection model to control for observed beneficiaries characteristics and unobserved confounders. The difference in raw, unadjusted mortality probabilities was 0.5{\%} (HMO lower). Correcting for numerous observed confounders resulted in a difference of -0.6{\%}(HMO higher). Further adjustment for unobserved confounders resulted in an estimated difference of 3.7 and 4.2{\%} (HMO lower), depending on the specification of geographic-fixed effects. The latter result (4.2{\%}) was statistically significant and consistent with prior studies that did not adjust for unobserved confounding. Our findings suggest there may be unobserved confounders associated with adverse selection in the HMO sector, which had a large effect on our mortality estimates among HMO enrollees. An important topic for further research is to identify such confounders and explore their relationship to mortality. The methods presented in this paper represent a promising approach to comparing outcomes between the HMO and FFS sectors, but further research is warranted.",
keywords = "HMOs, Medicare, Mortality",
author = "Dowd, {Bryan E} and Maciejewski, {Matthew L.} and O'Connor, {Heidi L} and Gerald Riley and Yisong Geng",
year = "2011",
month = "6",
day = "1",
doi = "10.1002/hec.1623",
language = "English (US)",
volume = "20",
pages = "645--659",
journal = "Health Economics (United Kingdom)",
issn = "1057-9230",
publisher = "John Wiley and Sons Ltd",
number = "6",

}

TY - JOUR

T1 - Health plan enrollment and mortality in the medicare program

AU - Dowd, Bryan E

AU - Maciejewski, Matthew L.

AU - O'Connor, Heidi L

AU - Riley, Gerald

AU - Geng, Yisong

PY - 2011/6/1

Y1 - 2011/6/1

N2 - Prior studies have found thatMedicare health maintenance organization (HMO) enrollees have lower mortality (over a fixed observation period) than beneficiaries in traditional fee-for-service (FFS) Medicare. We use Medicare Current Beneficiary Survey (MCBS) data to compare 2-year predicted mortality for Medicare enrollees in the HMO and FFS sectors using a sample selection model to control for observed beneficiaries characteristics and unobserved confounders. The difference in raw, unadjusted mortality probabilities was 0.5% (HMO lower). Correcting for numerous observed confounders resulted in a difference of -0.6%(HMO higher). Further adjustment for unobserved confounders resulted in an estimated difference of 3.7 and 4.2% (HMO lower), depending on the specification of geographic-fixed effects. The latter result (4.2%) was statistically significant and consistent with prior studies that did not adjust for unobserved confounding. Our findings suggest there may be unobserved confounders associated with adverse selection in the HMO sector, which had a large effect on our mortality estimates among HMO enrollees. An important topic for further research is to identify such confounders and explore their relationship to mortality. The methods presented in this paper represent a promising approach to comparing outcomes between the HMO and FFS sectors, but further research is warranted.

AB - Prior studies have found thatMedicare health maintenance organization (HMO) enrollees have lower mortality (over a fixed observation period) than beneficiaries in traditional fee-for-service (FFS) Medicare. We use Medicare Current Beneficiary Survey (MCBS) data to compare 2-year predicted mortality for Medicare enrollees in the HMO and FFS sectors using a sample selection model to control for observed beneficiaries characteristics and unobserved confounders. The difference in raw, unadjusted mortality probabilities was 0.5% (HMO lower). Correcting for numerous observed confounders resulted in a difference of -0.6%(HMO higher). Further adjustment for unobserved confounders resulted in an estimated difference of 3.7 and 4.2% (HMO lower), depending on the specification of geographic-fixed effects. The latter result (4.2%) was statistically significant and consistent with prior studies that did not adjust for unobserved confounding. Our findings suggest there may be unobserved confounders associated with adverse selection in the HMO sector, which had a large effect on our mortality estimates among HMO enrollees. An important topic for further research is to identify such confounders and explore their relationship to mortality. The methods presented in this paper represent a promising approach to comparing outcomes between the HMO and FFS sectors, but further research is warranted.

KW - HMOs

KW - Medicare

KW - Mortality

UR - http://www.scopus.com/inward/record.url?scp=79953766051&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79953766051&partnerID=8YFLogxK

U2 - 10.1002/hec.1623

DO - 10.1002/hec.1623

M3 - Article

VL - 20

SP - 645

EP - 659

JO - Health Economics (United Kingdom)

JF - Health Economics (United Kingdom)

SN - 1057-9230

IS - 6

ER -